Form Fms 232 - Specific Power Of Attorney

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Specific Power of Attorney
BY INDIVIDUAL FOR THE COLLECTION OF A
U
S
T
SPECIFIED CHECK DRAWN ON THE
NITED
TATES
REASURY
Know all by these Presents:
That the undersigned, ____________________________ , of ___________________________________
(address)
does hereby appoint _____________________________ , of ___________________________________
(address)
as his/her attorney to receive, endorse, and collect check No. ___________________________________ ,
dated ___________ , 20 ___ for _____________________________ dollars drawn on the United States
Treasury, by _________________________________________________________________ in favor of
______________________________________ , and to give full discharge for same; hereby ratifying and
confirming all that said attorney shall lawfully do or cause to be done by virtue hereof.
WITNESS the signature of the undersigned, this ________ day of ___________________ , 20 ____
______________________________
_____________________________
(Signature of grantor)
(Signature of Witness)
_____________________________
(Signature of Witness)
* Personally appeared before me the above-named ________________________________________________
known or proved to me to be the same person who executed the foregoing instrument, and acknowledged to me
that he executed the same as his free act and deed.
WITNESS my signature, official designation, and seal.
________________________________
[IMPRESS SEAL HERE]
(Signature of attesting officer)
________________________________
(Official designation)
Dated at ____________________ , this ______ day of ____________________ , 20 _____
My commission expires ______________________, 20 _____
IMPORTANT – Do not execute this instrument without first reading the instructions on the next
page. Exact compliance with these instructions will avoid complications.
* See Instructions on next page – Paragraphs 2(a) and 2(b)
DEPARTMENT OF THE TREASURY
FMS
FORM
232
(SUPERSEDES SF 232 (FEBRUARY 1975)
FINANCIAL MANAGEMENT SERVICE
1-04

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